Sleijser-Koehorst Marije L S, Coppieters Michel W, Epping Rob, Rooker Servan, Verhagen Arianne P, Scholten-Peeters Gwendolyne G M
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.
Physiotherapy. 2021 Jun;111:74-82. doi: 10.1016/j.physio.2020.07.007. Epub 2020 Jul 28.
To determine the diagnostic accuracy of patient interview items and clinical tests to diagnose cervical radiculopathy.
A prospective diagnostic accuracy study.
Consecutive patients (N=134) with a suspicion of cervical radiculopathy were included. A medical specialist made the diagnosis of cervical radiculopathy based on the patient's clinical presentation and corresponding Magnetic Resonance Imaging findings. Participants completed a list of patient interview items and the clinical tests were performed by a physiotherapist.
Diagnostic accuracy was determined in terms of sensitivity, specificity, and positive (+LR) and negative likelihood ratios (-LR). Sensitivity and specificity values ≥0.80 were considered high. We considered +LR≥5 and -LR≤0.20 moderate, and +LR≥10 and -LR≤0.10 high.
The history items 'arm pain worse than neck pain', 'provocation of symptoms when ironing', 'reduction of symptoms by walking with your hand in your pocket', the Spurling test and the presence of reduced reflexes showed high specificity and are therefore useful to increase the probability of cervical radiculopathy when positive. The presence of 'paraesthesia' and 'paraesthesia and/or numbness' showed high sensitivity, indicating that the absence of these patient interview items decreases the probability of cervical radiculopathy. Although most of these items had potentially relevant likelihood ratios, none showed moderate or high likelihood ratios.
Several patient interview items, the Spurling test and reduced reflexes are useful to assist in the diagnosis of cervical radiculopathy. Because there is no gold standard for cervical radiculopathy, caution is required to not over-interpret diagnostic accuracy values.
确定患者访谈项目和临床检查对诊断神经根型颈椎病的诊断准确性。
一项前瞻性诊断准确性研究。
纳入了连续的134例疑似神经根型颈椎病患者。由医学专家根据患者的临床表现和相应的磁共振成像结果做出神经根型颈椎病的诊断。参与者完成了一份患者访谈项目清单，临床检查由物理治疗师进行。
根据敏感性、特异性、阳性（+LR）和阴性似然比（-LR）确定诊断准确性。敏感性和特异性值≥0.80被认为是高的。我们认为+LR≥5且-LR≤0.20为中等，+LR≥10且-LR≤0.10为高。
病史项目“手臂疼痛比颈部疼痛更严重”、“熨烫时症状诱发”、“手插兜行走时症状减轻”、斯珀林试验以及反射减弱显示出高特异性，因此当结果为阳性时，有助于提高神经根型颈椎病的患病概率。“感觉异常”和“感觉异常和/或麻木”的存在显示出高敏感性，表明这些患者访谈项目不存在会降低神经根型颈椎病的患病概率。尽管这些项目中的大多数具有潜在相关的似然比，但没有一个显示出中等或高似然比。
几个患者访谈项目、斯珀林试验和反射减弱有助于神经根型颈椎病的诊断。由于神经根型颈椎病没有金标准，因此需要谨慎，不要过度解读诊断准确性值。
